Nico Nortjé

Treating an intervention level 1 patient: futile or brave?

Abstract An ethical dilemma describes conflicting opinions by different members of the care team. This article focuses on AJ, a five-year-old child with cerebral palsy, who was born deaf and blind as a result of having contracted rubella in utero. The case is examined against Sokol’s four-quadrant analysis of ethical issues, giving a framework designed to facilitate the systematic identification and analysis of clinical ethical problems. The issue is whether the medical team should have palliated AJ, or continued with invasive therapy and feeding. The conclusion is that paediatric palliative care is often difficult, but that the dietitian has a duty to contribute his or her knowledge to benefit the patient.

Psychofortology of Women Undergoing Infertility Treatment

This study explored the coping and subjective well-being of women undergoing infertility treatment. Participants were 61 South African women attending a fertility clinic was selected by means of non- probability purposive sampling (mean age = 34.5). Data were gathered by means of a self-report survey consisting of various questionnaires and analysed using descriptive statistics and cluster analysis. Participants reported lower total coping resources compared to the mean of 50 as established by Hammer and Marting (1988). The participants had an average sense of coherence and the majority experienced a below average feeling of happiness. Cluster analysis of the patterns of coping resources, sense of coherence, satisfaction with life and happiness of women currently undergoing infertility treatment at a privately managed health care unit revealed three distinct clusters that differed significantly across the four measures. The results suggest that the women in this sample, despite the experience of infertility and infertility treatment, were able to comprehend, manage and find meaning of their experience in the context of other aspects of their lives.

Emily Hobhouse’s Psychosocial Developmental Trajectory as Anti-War Campaigner: A Levinsonian Psychobiography

Abstract The aim of this psychobiography was to uncover, reconstruct and illustrate significant trajectories of psychosocial development and historical events over the lifespan of Emily Hobhouse (1860-1926). The British-born Hobhouse later became an anti-war campaigner and social activist who exposed the appalling conditions of the British concentration camps during the Anglo-Boer War (1899-1902), as evidenced by primary and secondary historical data. Purposive sampling was used to select Hobhouse as a significant and exemplary subject. Levinson’s four eras or seasons of lifespan development served as the theoretical psychological approach. The study was undertaken against the background of Merleau-Ponty’s ontological philosophy that elucidates a human science phenomenology where the individual cannot be separated from her social world. Alexander’s model of identifying salient biographical themes was utilized and a conceptual psycho-historical framework, based on both the life cycle theory of Levinson and significant historical periods throughout Hobhouse’s life, was employed to assist with data gathering, categorisation, and analyses. The findings highlight significant psychosocial and historical events in the life of Hobhouse that shaped her development as an anti-war campaigner. These include: The role of her strong-willed and determined mother; the denial of an opportunity to study and pursue a formal education; her management of painful feelings of abandonment and grief; the care of her father during his illness and his eventual death; the abrupt ending of her failed romantic relationship; her networking capacity; and her open-mindedness and capacity for independent humanitarian thought. Against the philosophical background of Merleau-Ponty’s phenomenological ontology, Levinson’s theory and eras proved valuable in identifying these particular psychosocial life experiences and historical events as having shaped Emily Hobhouse into an antiwar campaigner.

Bioethics and Its Development on the African Continent

What makes a good person good? Can a wrong action be a good action and consequently can a right action be a bad action? These are questions which have plagued philosophers and wise persons of antiquity and is still relevant all over the world, including Africa. The aim of this chapter is to position African ethics within the framework of Global Bioethics and initiate the conversation that although ethics in Africa is often still practiced from a Western paradigm, African ethics have developed significantly in the post-colonial era to inform healthcare delivery on the continent. Whilst the chapter will not focus on the development of historical ethical theories, it will take a critical look at Western contributions to the modern-day discipline and how this has influenced ethics on the continent of Africa. This chapter will attempt to sketch the development and influence of ethics in Africa and what the future looks like for the discipline in Africa.

Curriculum Guidelines for Teaching Healthcare Ethics at Undergraduate Level

Undergraduate courses in healthcare ethics should primarily focus on taking students on a journey that facilitates growth in the theoretical and practical areas of deliberation and ethical decision-making skills. A sound knowledge of the most prominent moral theories, together with knowledge of widely-recognised bioethics principles and medical law principles should underpin the course content. Ultimately healthcare ethics courses should result in skills that will empower students to effectively function in their specific professional healthcare fraternities. The first section of this chapter describes the rationale for the inclusion of four broad learning units. Each of these learning units will be subdivided into one or more modules. The Ethics principles learning unit includes the following modules: (1) Overview of ethics; (2) Moral theories; (3) Fundamental ethics principles; and (4) Clinical research ethics. The Ethical reasoning learning unit consists of only one module, while the Professional skills learning unit includes the following two modules: (1) Professionalism; and (2) Communication. The Legal considerations in healthcare learning unit consists only of a Medical law module. The second section of this chapter focuses on a description of each module’s specific learning outcomes. The aim of these learning outcomes is to ensure that healthcare students acquire knowledge, skills and attitudes that achieve deep learning and fundamental understanding of ethical principles, ethical reasoning, professional skills and medical law principles. The third section of this chapter focuses on a description of the assessment tasks that can be used in dynamic interaction with theory and practice throughout the undergraduate healthcare ethics course. The various assessment tasks focus on evidence-based endeavours to determine and establish the extent to which students have internalised the required sets of knowledge, skills and attitudes regarding ethics concepts and principles, ethical reasoning, professional skills and legal considerations in healthcare.

Development of Bioethics and Professionalism in the Healthcare Context

Bioethics is concerned with reflections on the actions, thoughts, motivations and intentions of the “good” healthcare professional. These reflections have a long history and continue to expand as healthcare technology and contexts develop and change at a rapid pace. On the one hand it has resulted in the external codification of various principles and the establishment of professional bodies, while on the other hand it has sparked interest in professionalism as an inherent virtue. The first section of the chapter provides a basic definition of bioethics. This is followed in the second section by an overview of the most important developments in bioethics, specifically with regards to the development of various international codes and guidelines following in particular the Nazi atrocities in World War II. An overview is provided of the following codes/guidelines: Nuremburg Code (1947); Universal Declaration of Human Rights (1948); Declaration of Helsinki (1964); Belmont Report (1979); Principlism and the Universal Declaration on Bioethics and Human Rights (2005). The third section focuses on the development of bioethics in South Africa, specifically with regards to the role of healthcare practitioners and professional bodies during Apartheid (pre-1994) and post-Apartheid (1994 till present). The last section of the chapter highlights the important role of professionalism as a healthcare virtue. It describes the basic characteristics of professionals, which is then followed by a description of five focal virtues that healthcare practitioners should possess, namely compassion, discernment, trustworthiness, integrity and conscientiousness.

School tuck shops in South Africa—an ethical appraisal

It can be postulated that schools have an ethical responsibility to protect children from an unhealthy food environment. Against the backdrop of stunting, overweight and micronutrient deficiencies prevalent in South African children, the aim of this scoping study is to review information available on foods sold to school children within an ethical framework. While some schools have a formal tuck shop, at other schools, food vendors sell food either on or outside the school premises. Ten studies, of which two were national, fit the selection criteria for this study. Available data show that mostly unhealthy food options are sold to South African school children; with low-nutrient energy-dense foods (e.g. chips, sweets) and sugar sweetened beverages being the most popular. The Integrated School Health Policy provide a policy framework for achieving healthy school food environments in South Africa, and several guidelines are available in South African to assist school tuck shops to sell healthier options. Children’s preference for unhealthy foods, the cost of healthier food options and a lack of proper facilities may however be barriers for implementing healthy tuck shops. An action stronger than merely providing guidelines may therefore be needed. Cognisance needs to be taken of conflicting value based arguments within ethical perspectives. Given these conflicts, the authors argue that an Ethics of Responsibility contributes to the debate of the best and supports the notion that society at large has a responsibility to protect vulnerable communities of which school children are part. Presently an ethical vacuum exists in terms of rights and responsibilities which this study hopes to address.

Patterns of unprofessional conduct by medical practitioners in South Africa (2007–2013)1

A role of ethics in the medical context is to protect the interests, freedoms and well-being of patients. A critical analysis of unprofessional conduct by medical practitioners registered with the Health Professions Council of South Africa (HPCSA) requires a better understanding of the specific ethics misconduct trends. To investigate the objectives the case content and sanctions of all guilty decisions related to unprofessional conduct against HPCSA-registered medical practitioners in the period 2007 to 2013 were analysed. A mixed methods approach was followed. The quantitative component focused on annual frequency data regarding the number of decisions taken against practitioners, number of practitioners, number of specific sanctions and categories. Relatively few medical practitioners (between 0.11% and 0.24%) are annually found guilty of unprofessional conduct. The annual average number of guilty decisions per guilty medical practitioner ranged between 1.29 and 2.58. The three most frequent sanctions imposed were fines between ZAR10 000 and ZAR15 000 (28.29%), fines between ZAR1 000 and ZAR8 000 (23.47%) and suspended suspensions between 1 month and 1 year (17.37%). The majority of the unprofessional conduct involved fraudulent behaviour (48.4%), followed by negligence or incompetence in evaluating, treating or caring for patients (29%). Unethical behaviour by medical practitioners in South Africa occurs relatively infrequently.